Healthcare Provider Details

I. General information

NPI: 1972061596
Provider Name (Legal Business Name): ELITE MEDICAL MEMPHIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 POPLAR AVE STE 211A
MEMPHIS TN
38112-3209
US

IV. Provider business mailing address

1568 SOUTHLAKE PKWY
MORROW GA
30260-4153
US

V. Phone/Fax

Practice location:
  • Phone: 901-701-1063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: EMMA CULL
Title or Position: COO
Credential:
Phone: 678-469-5011